Synopsis
Recognise injury patterns and contextual features that may indicate physical abuse, stabilise urgent harm, take a developmentally informed history, initiate proportionate investigations, document objectively and refer promptly through local child-protection pathways.
- Treat urgent injury first while safeguarding actions run in parallel; protection must not delay resuscitation, analgesia or necessary imaging.
- Compare the proposed mechanism with the child's actual developmental ability, injury location, severity and reported timing.
- Speak with the child in an age-appropriate way when safe, ask only open non-leading questions and record important words verbatim.
- Examine the fully undressed child respectfully, including scalp, mouth, ears, trunk, limbs, hands and feet, and assess growth and development.
- Do not date bruises by colour or declare a single lesion diagnostic of abuse; interpret the complete pattern with relevant specialists.
- Request senior paediatric review and follow local imaging, laboratory, ophthalmology and forensic-photography protocols for suspected maltreatment.
- Share concern with children's social care promptly; involve police immediately when a crime or urgent protection issue may be present.
- Document facts, observations, diagrams, measurements, exact accounts, information sources and the clinical reasoning behind each decision.
Key red flags
The explanation is absent, changes substantially, conflicts between observers or does not account for the severity, location or developmental plausibility of the injury.
A non-mobile infant has bruising, an oral injury, an unexplained fracture, a burn or another injury that cannot reasonably be self-inflicted.
Injuries are multiple, patterned, in protected sites, at different apparent stages of healing or accompanied by delay in seeking necessary care.
The child shows fear, flinching, extreme vigilance, an implausibly rehearsed account or reluctance to leave with a particular person.
Head injury symptoms, abdominal tenderness, breathing difficulty, circulatory compromise or altered behaviour may signal occult life-threatening trauma.
Previous safeguarding concerns, domestic abuse, coercive control or sibling injury increase context but never replace assessment of the present evidence.
Investigation priorities
Identify injury, illness, developmental capability and immediate treatment needs.
Management branches
The child has serious injury, physiological instability or an immediate threat.
- Run ABCDE and deliver analgesia and emergency treatment immediately.
- Call senior paediatric, surgical, anaesthetic or critical-care support as indicated.
- Notify safeguarding leads, children's social care and police through emergency routes.
- Agree documented supervision and prevent an unsafe departure using lawful local procedures.